The Third Report: Country Leadership and Collaboration on NTDs
Endemic countries are demonstrating strong ownership and leadership, in variable financial, political and environmental circumstances, to ensure their NTD programs are successful in meeting 2020 targets. Countries are achieving elimination goals, more people are being reached, and the drug donation program for NTDs, the largest public health drug donation program in the world, continues to grow.
This third progress report of the London Declaration on NTDs showcases examples of countries making strides toward increasing domestic investments to control and eliminate NTDs and provides a compelling case for why NTDs are a development best buy.
In the course of human history, few public health efforts can match the scale and ambition of the endeavor to rid the world of 10 Neglected Tropical Diseases (NTDs). These efforts have accelerated over the last three years, as a diverse group of players have come together in one of the largest ever public-private partnerships to deliver the funding, drugs and technical assistance required.
Within this third report on progress since the 2012 London Declaration, five principal themes emerge:
- NTDs provide one of the strongest returns on investment in public health
- Leadership among endemic countries has shown a substantial increase
- The largest drug donation program in the world continues to grow
- Coverage is increasing, but the pace is too slow to meet key milestones
- National NTD programs are achieving elimination goals
The scorecard is a collection of indicators and milestones compiled from the NTD specific community and WHO.
Progress towards achieving the goals is followed by relying on WHO data where possible and with additional input from partners as needed.
The Stakeholders Working Group, comprised of representatives from all stakeholder groups reviews progress, and makes a determination (following on from the initial assessment of progress by the disease specific communities) of the final scoring (red, yellow, or green) for each disease, according to set criteria and note why the decision was made.
Yellow and red scores are not a judgement of the program itself but rather a call to action that additional course correction and resources may be required to achieve program goals.
In the past year, the collective NTD community has continued to make significant progress towards the WHO roadmap targets. The most significant progress was made in human African trypanosomiasis where cases hit a 75 year low with 3,796 cases found after similar numbers were screened. However, as we progress through 2015, it is already clear that many of this year’s critical milestones will not be met. We will not achieve full scale up of the delivery of PCT for LF in all endemic countries.
Country leadership on NTDs
Countries are demonstrating strong political ownership and leadership, in variable financial, political and environmental circumstances, to ensure their NTD programs are successful in meeting 2020 targets.
A key element of country leadership is domestic investment. However, while this is crucial to bridging the estimated US$200-$300 million annual global funding gap, as well as to increasing country ownership, it is by no means the only contribution needed.
Other important, replicable innovations that are expected to have a significant impact on country performance in achieving control and elimination goals include:
- Decentralizing program management to the regional and district levels;
- Transitioning from siloed disease efforts to full integration of PCT diseases, reaching more and costing less;
- Actively coordinating with education counterparts to ensure school-based drug delivery programs share costs, resources, and reach optimal numbers of school-aged children;
- Actively advocating for NTD control and elimination through public events; and
- Thinking creatively about ways to raise domestic funds, including identifying local celebrity spokespeople for NTDs, engaging host country footballers playing in the European League, and adding a $1 surcharge onto national airline ticket sales, with funds going to NTD treatment gaps
Addis Ababa Commitment on NTDs, 2014
Whereas the Ministers of endemic countries have already endorsed and committed to achieving the WHO Roadmap goals through passage of the WHA 66.12, we, the undersigned Ministers further commit to:
- Work to increase our domestic contribution to the implementation of NTD programs through the expansion of government, community and private sector commitments;
- Promote a multi-sectorial approach to the implementation of NTD program goals that improves national coordination, facilitates partner collaboration, and improves the management of technical and financial contributions;
- Ensure the adoption of both long-range strategic and annual implementation plans which are grounded by appropriate goals and detailed costs that drive and support NTD programs to achieve global targets;
- Report and use program data in a timely fashion to follow progress against program goals and to inform program planning and execution; and
- Ensure that the implementation of NTD programs contribute to the strengthening of the overall health system and vice versa.
Current Endorsers: Burkina Faso, Burundi, Brazil, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Gabon, The Gambia, Ghana, Guinée Conakry, Guinée Bissau, Kenya, Liberia, Mali, Malawi, Niger, Nigeria, South Sudan, Sudan, Tanzania, Togo, and Uganda
Domestic financing for NTDs
Several countries are showing great initiative on domestic financing for NTD programs, in several instances exhibiting remarkable leadership and foresight in the face of challenging conditions. Some have already taken on primary responsibility for financing their NTD program: Bangladesh and the Philippines pay for 85% and 94% of their NTD programs, respectively, and Honduras recently became the first Latin American country to launch a national NTD program fully supported by the government.
In Africa too there has been progress in this direction, with 43 (of 47) endemic countries now operating integrated NTD programs.
World Bank facility offers potential NTD financing route for poorer nations
If NTDs are prioritized by low-income countries in their health-sector strategies, International Development Assistance (IDA) funds can provide a reliable source of domestic funding for NTDs. According to the World Bank, low-income countries, including those endemic for NTDs – are eligible for support from IDA funds depending on their relative poverty, which is defined as the Gross National Income (GNI) per capita. 77 of the poorest countries in the world qualify for support from this facility, 39 of which are in Africa (see www.worldbank.org/ida/borrowingcountries.html).
During the 2014 financial year:
- Lending to 74 low income countries, 36 of them in Africa, amounted to US$22.2 billion.
- For 2015, lending was extended to 61 countries, (32 in Africa), amounting to US$19 billion.
- Of the 2015 lending, US$2.2 billion went to health, nutrition and population whilst education received US$1.8 billion.
- Part of these resources could have been used for NTD interventions.
- Evidence shows NTDs have a negative impact on the economic stability of families, communities and countries and those countries that apply for IDA resources should be encouraged to include support for NTD programs within their development plans, including their national health and education strategies/policies/plans.
New Leadership in Africa
For the first time in its 66-year history, WHO AFRO has a woman at its helm. Earlier this year, Dr. Matshidiso Moeti, originally from South Africa,was appointed as WHO’s Regional Director for the Africa Region.
“It’s an honor bestowed on me to serve my continent and Member States as the first woman WHO Regional Director....
As a Regional Director of WHO in a region that is currently experiencing the highest burden of NTDs, I made a commitment to Ministers of Health that tackling NTDs will be one of my top priorities…
We must take every advantage of the donations of medicines that pharmaceutical companies are providing and ensure that they get to all the people that need them until the diseases are eliminated or eradicated.”
NTDs: a development best buy
Work completed this year by Erasmus indicates that NTD programs have a high return on investment and that by targeting NTDs, you reach the poor globally and nationally. This makes NTD programs a pro-poor best buy.
The report shows that if countries achieve the World Health Organization’s 2020 goals for these diseases:
- healthier citizens would generate an estimated US$623 billion in increased productivity between 2015 and 2030
- nearly 600 million disability-adjusted life years (DALYs) will be averted
- Similarly, if NTD goals are reached, the ongoing health benefits from 2011 through 2030 will be of the same order of magnitude as HIV/AIDS, tuberculosis and malaria
Drug donation and delivery
A cornerstone of both the global NTD program and the London Declaration is the generous contribution of donated drugs from pharmaceutical companies.
- Together the NTD drug donation programs are the largest of their kind in public health,
- Pharmaceutical companies have pledged drugs valued at US$17.8 billion for the 10 London Declaration Diseases through to 2020.
- Over 5.5 billion tablets have been donated providing 3.5 billion treatments since the launch of the London Declaration in 2012.
- In 2014 1.45 billion treatments were made available to endemic countries, representing a 36% increase since 2011.
Efficient and effective supply-chain management plays a critical role in ensuring that NTD medicines are delivered to the people who need them. Aimed in part at streamlining and coordinating this process, the NTD Supply Chain Forum (the “Forum”) was established in 2012, bringing together the WHO, pharmaceutical donor partners (GSK, Johnson & Johnson, Pfizer, Merck & Co, Inc., Merck KGaA, and Eisai), the Gates Foundation, logistics partner DHL, and non-governmental organizations (Children Without Worms, the Mectizan® Donation Program, the International Trachoma Initiative and RTI International).
The efforts of the Forum over this past year have resulted in progress in improving drug production timelines, changes in national drug application mechanisms, and better distribution and delivery to the destination countries.
Innovative Program Collaboration
Collaboration across countries, between non-governmental development organizations; across government departments and sectors, between WHO and its partners; and across organizations with differing but complementary priorities, is a unique feature of NTD programs and a key driver of progress in the fight against NTDs.
From the Global Trachoma Mapping Project, which will see an average of 2,400 people per day or roughly one person per minute examined over its lifespan; to the record gathering of 70 organizations for the 2014 meeting of the Neglected Tropical Disease NGDO Network (NNN), together we can achieve results.
GTMP: the largest disease mapping project in history
The aim of the Global Trachoma Mapping Project (GTMP) is to accurately map the prevalence of trachoma, the world’s leading infectious cause of blindness. In under two and a half years, GTMP partners have worked with 23 ministries of health, using population based survey methods to capture evidence of disease prevalence covering a suspected endemic population of 212 million people.
GTMP has exceeded all expectations. Over the lifetime of the project 1,494 health districts have been mapped, leaving approximately 100 accessible, suspected-endemic health districts still to be mapped in 2015. The GTMP population based survey methods have been recognized by WHO and the International Trachoma Initiative (ITI) as gold standard epidemiological surveys for trachoma. Ministries of health use GTMP trachoma baseline data to apply for donations of the antibiotic Zithromax® from Pfizer.
Collaboration on tracking STH shows progress
Preschool-age children are an important target group for STH control with preventive chemotherapy in the WHO strategic plan on ‘Eliminating Soil-Transmitted Helminthiases as a Public Health Problem in Children’. WHO and its partners recognize that not all countries requiring preventative chemotherapy for STH reported data to the PCT databank. In particular, data from Child Health Days, which are biannual events delivering a package of child health interventions to pre-SAC, appeared to be incompletely captured. In these events, vitamin A supplementation and deworming are among the most common interventions.
To address the reporting gap for deworming delivered through Child Health Days, UNICEF launched a global reporting exercise linked to UNICEF’s well established reporting system for global vitamin A coverage.
With this additional data, the global 2013 pre-SAC reported coverage increased from 24% to 49%, thus surpassing the 2013 coverage milestone and showing that the coverage target for 2015 (50%) is achievable.
Primary prevention for the control of NTDs relies heavily on improved water, sanitation, and hygiene (WASH). There are numerous NTD transmission routes that can be interrupted with improved WASH. In addition to preventing disease, improved WASH is vital to NTD-related wound and morbidity management and disability prevention.
To date, NTD control initiatives have relied predominantly on mass drug administration (MDA). While MDA includes the treatment of disease, as well as delivery of drugs as preventive chemotherapy (PCT), studies have shown continued re-infection post-PCT where WASH interventions are not part of the strategy.
We welcome the new WHO strategy which can only serve to strengthen the collaboration between the NTD and WASH sectors, towards the common goal of meeting the WHO Roadmap targets for NTDs.
Achievements of the Guinea Worm Eradication Program are a testament to what is possible in NTDs.
Since 1983, the global program has successfully eliminated GWD in 81% of all formerly endemic countries (17/21). Cases in 2015 are at an all-time low of 5 as at the end of May. Eight countries remain to be certified: Chad, Ethiopia, Mali and South Sudan remain endemic; Kenya and Sudan are at pre-certification stage; and Democratic Republic of Congo and Angola (not known to be endemic), but still have to be certified by WHO. Onchocerciasis was eliminated in Colombia and Ecuador and trachoma was eliminated in Oman.
Some countries have also made progress in stopping treatment in all or some foci. These include Mexico, Guatemala, Uganda, Sudan, Mali and Senegal. Of the remaining 73 countries endemic for LF, 16 countries (22%) are no longer in need of mass drug administration (MDA). Malawi has just announced that they have reached a stage where treatment is no longer needed, increasing that number to 17 countries. These amazing accomplishments show that the ambitious goals set are achievable with effort and resources.
Lymphatic filariasis (LF) is a mosquito-transmitted disease caused by parasitic worms that damage the human lymph system. It can cause severe and sometimes very extensive swelling of the lower limbs (lymphedema), which can be accompanied by painful episodes of fever. LF afflicts the poorest communities, preventing affected individuals from living a productive working and social life, further trapping them in the cycle of poverty.
Current Scorecard Progress: for the last three years
LF remains yellow. Despite significant progress, the rate of scale up remains below the target. Mapping of prevalence continues. The target of full geographic scale up in all endemic countries is unlikely to be achieved in time to allow 5 years of treatment prior to 2020. If mapping reveals a lower population in need of treatment, and if resources (financial and human) are available, significant progress could be made in the next year to fill the gap.
- 120 million people infected
- 494.5 million people treated worldwide in 2013
Onchocerciasis (or river blindness) is a disease caused by infection with a parasitic worm transmitted by blackflies, which breed in fast-flowing streams and rivers. Adult worms produce larvae (microfilariae) that migrate to the skin, eyes, and other organs, and can cause debilitating itching, disfiguring skin conditions, and visual loss (including irreversible blindness) over time. Onchocerciasis can therefore impact enormously on the lives of those infected, reducing their ability to work and learn.
Current Scorecard Progress:
Oncho remains yellow, as the program is now targeting elimination not just control, which means more people need to be reached as hypo-endemic areas are included. The number of people reached with MDA increased in 2013, although overall coverage decreased, as the inclusion of hypo-endemic areas increased the number needing treatment.
The closure of the African Program for Onchocerciasis Control (APOC) in December 2015 leaves support for the program uncertain, though efforts are underway to put in place a regional entity to support country programmes.
- 169 million people at risk
- 100.7 million people treated in 2013
Schistosomiasis (snail fever or bilharzia) is an infectious tropical illness that people can develop when they come into contact with fresh water contaminated by certain snails carrying the disease-causing parasites, which penetrate the skin and migrate through the body. Infection primarily affects the urinary or intestinal system, causing chronic ill health and in some cases death.
Poor hygiene and water-based activities (such as swimming and fishing) make school-age children the most vulnerable, with infection responsible for malnutrition, absenteeism, and impaired intellectual development. Children suffering from persistent and severe schistosomiasis infections are also likely to have chronic irreversible diseases later in life, such as scarring (fibrosis) of the liver, bladder cancer, or kidney failure.
Current scorecard progress:
Schistosomiasis remains red as it has the lowest coverage of all PCT diseases at 14.4% in 2012 and 15.6% in 2013. In addition, new mapping of schisto in AFRO countries is increasing the number of identified endemic districts. Twenty-six countries (50%) of 52 endemic countries reported MDA in 2013. Significant improvements could be made in the next cycle as drug supply is expected to increase and the launching of the new Global Schistosomiasis Alliance will increase collaboration within this disease community to help countries scale up.
- 261 million people need treatment
- 47.3 million people treated worldwide in 2013
Soil-transmitted helminthiasis (STH, or intestinal worms) is caused by a group of intestinal parasites that thrive in places where the soil is warm and humid, and sanitation is poor. The most common STH-causing parasites are roundworm, whipworm, and hookworm. People become infected after they come in contact with soil contaminated with the parasites’ eggs.
STH reduces the body’s ability to absorb nutrients and vitamins, which exacerbates malnutrition, and leads to anemia, increased susceptibility to other infectious diseases, stunted growth, and impaired intellectual development.
Symptoms of STH become more evident as the worm load in an infected person increases. STH is a poverty-related disease, linked to broader community development challenges, which severely limits the ability of those infected to live full and productive lives.
Current scorecard progress:
STH moved from yellow to green. Improved coordination between UNICEF and WHO has led to an improvement in reporting of coverage for pre-school children which now exceeds 50%. Coverage in school-age children is 39%, which is on track for a 75% target in 2020.
Coordination of partners as a result of the STH Coalition and the improvement in resources and coverage, are the main drivers for moving to green. However, increases in coverage of preschool- aged children were primarily due to improved reporting and STH is highly dependent on LF coverage. STH-specific implementation efforts need to increase to maintain a green status.
- 876 million at risk children worldwide
- 50% of at risk preschool-age children children treated in 2013
Trachoma is a disease caused by a contagious bacterial infection of the eye commonly spread through contact with contaminated hands or items such as clothing, and by flies coming into contact with a person’s eyes or nose.
Trachoma often begins in early childhood, progressing over the years as episodes of reinfection cause inflammation and scarring of the inner eyelid. In some people, repeated infection damages the eyelids (compromising the eye surface’s normal defenses), and the eyelashes turn inwards, painfully rubbing against the eye’s surface (a condition known as trichiasis).
If left untreated, a series of complications can lead to irreversible blindness. Trachoma is directly linked to poverty, and communities without access to clean water or effective sanitation are the most vulnerable to it. The disease has a devastating impact on livelihoods, as it limits access to education and prevents individuals from being able to work or care for themselves or their families.
Current scorecard progress:
Trachoma remains green due to its strong partnerships, available resources, and momentum. Trachoma has made tremendous strides in the ambitious mapping efforts. In order for progress to be maintained, drug supply issues, coverage of the F and E components of the SAFE strategy, as well as implementation in the growing number of new districts being identified through the mapping exercise, will need to be addressed.
- 232 million people at risk
- 54.7 million received antibiotics in 2014
Chagas disease is a parasitic infection often caused by contact with the feces of infected bloodsucking insects (called “kissing bugs”) which infest people’s homes. It is also known for the illness to be passed on by eating food contaminated by the insects, through blood transfusions or organ transplants, or to children at birth.
After an often mild acute phase of a few weeks, with non-specific symptoms such as fever, body aches, rash, diarrhea, and vomiting, most people will go for a long time without showing any signs of the disease, and in many instances will be unaware they have the illness. An estimated 30-40% of infected people will eventually develop serious complications, including heart disease and enlargement of the colon and/or esophagus, which can incapacitate and quite frequently result in death.
Current scorecard progress:
Chagas changed from green to yellow as only 14% of endemic Latin American countries have verified interruption of intra-domiciliary vectoral transmission compared to a target of 30%. Progress measurement has been hampered by a lack of availability of data and lack of partner coordination. However, a newly forming coalition is expected to help, by improving indicators for the partners’ contributions, which may encourage increased investments in Chagas. This and better access to annual treatment data may move this back to green in the next cycle.
- 70 million people at risk globally
- 95% of at risk Latin American countries screen blood donations
Guinea Worm Disease
Guinea worm disease (GWD, or dracunculiasis) is an incapacitating parasitic illness caught by drinking from water containing water fleas infected with Guinea worm larvae. Once in the body, these larvae reproduce. Over 10-14 months, female larvae can grow to meter-long worms, which then begin to emerge from the skin through intensely painful blisters, usually on the legs or feet, accompanied by fever, nausea and vomiting.
Once a worm has started to emerge, it must be carefully and completely removed over a period of weeks. Often, the wound caused develops a secondary infection, increasing the time it takes for an infected person to resume normal activities. Failure to remove the worm can result in additional bacterial infection, as well as infection of the whole body (septicemia) and permanent disability.
Current scorecard progress:
GWD remains yellow due to the fact that the 2015 target to end transmission will not be reached. There are also concerns over filling the new funding gap up to the new target of 2020. There has nonetheless been good progress such as Ghana being certified GWD-free in January 2015 and a 48% decrease in the number of villages reporting cases between 2013 and 2014. Four countries are awaiting certification as GWD-free (DRC, Angola, Kenya, and Sudan). If cases are found in any pre-certification country, if cases do not significantly decrease, and if the funding gap is not resolved this would likely be red in the following cycle. Initial data for 2015 shows a decrease in cases and some funding is coming in so we remain cautiously optimistic.
- 99.99% drop worldwide since 1986
- 80 million GWD cases averted globally over the past 30 years
Human African Trypanosomiasis
Human African trypanosomiasis (HAT, or sleeping sickness) is caused by infection with parasites transmitted to humans through the bites of infected tsetse flies. The disease manifests in two forms: chronic infection with Trypanosoma brucei gambiense (g-HAT) progressing over several years, and acute infection with Trypanosoma brucei rhodesiense (r-HAT) progressing over weeks or months.
In the first stage the parasites multiply in the body causing fever, headaches, joint pain, and itching. In the second stage, the parasites invade the central nervous system and brain, leading to behavioral changes, confusion, poor coordination, and sensory as well as sleep disturbances (giving the name sleeping sickness). Without diagnosis and treatment, HAT is nearly universally fatal in humans.
Current scorecard progress:
HAT stays green with cases at a 75 year low with 3,796 cases in 2014. The marked success of the control strategies applied, along with the introduction of a new rapid diagnostic test and new vector control tools such as the “tiny targets”, gives hope for steady progress in the following cycle.
The HAT community needs to ensure that program support is maintained at a high level, because reaching the milestone of lowest disease incidence will require reinforced surveillance in near-elimination foci.
- 21 million people living in highest risk areas
- Reduction in new cases in 2014 marks 75 year low in HAT transmission
Leprosy (or Hansen’s disease) is a chronic infectious disease caused by bacteria mainly spread through droplets from the nose and mouth of persons suffering from untreated leprosy (produced, for instance, when they sneeze or cough). The disease, which can have a long incubation period, causes disfiguring lesions on the skin and nerve damage.
The first stage of leprosy leads to loss of sensation and muscle weakness in facial muscles, hands and feet (Grade 1 disability). If the disease is not detected and treated, it progresses to a second stage that causes observable and permanent impairments, such as loss and/or shortening of fingers or toes, and vision loss (Grade 2 disability).
Leprosy is most common in areas of poverty, where overcrowding and poor nutrition make people more vulnerable to infection, and where it continues to be a major source of disability and social exclusion for persons affected and their families. The consequences of leprosy often persist beyond completion of treatment.
Current scorecard progress:
Leprosy moved from green to yellow, partly due to greater rigor of indicators. Additionally, there was poor reporting of data from endemic countries, with only 7 of 25 endemic countries reporting national data, making progress assessment difficult. We remain optimistic that the strong leprosy community and leadership may return leprosy to green in the next cycle.
- 215,700 new reported cases worldwide in 2013
- 100% take-up of WHO-endorsed strategies
Visceral leishmaniasis (VL, or kala-azar) caused by infection with leishmania parasites through bites of infected sandflies that breed in and around homes or farms. If VL progresses, it attacks the immune system and affects the bone marrow and internal organs (including enlargement and impaired function of the spleen and liver), as well as causing irregular bouts of fever, substantial weight loss, and anemia. Left untreated, VL can have a fatality rate as high as 100% within 2 years. The disease is linked to poverty and environmental changes.
Current scorecard progress:
VL moved from green to yellow due to temporary drug delay and poorly defined indicators. Approximately 915 treatments of AmBisome® due in 2014 were not distributed until March 2015, though this delay did not impact programming needs. Currently, 9 of 11 VL endemic countries in the Americas have provided updated epidemiological data. South-East Asia is reporting a reduction in incidence and case fatality rates as well as progress towards elimination, with a reduction in reported VL incidence and case fatality rate by 60% and 81% respectively in 2014. 80% of health facilities in East Africa have diagnostic and treatment capacity compared to less than 60% in 2010. With improved milestones and a refined research strategy plan, progress would be easier to measure and likely move towards green in the next cycle.
- 310 million people at risk in the six most heavily-affected countries
- Reported cases 59% down across three highest –burden countries (2011-2013)
Case study: Yemen
At the time of writing, the current situation in Yemen is concerning and unpredictable, with a social, political and humanitarian situation threatening the country’s stability. Yet just prior to the onset of this spring’s unrest, Yemen was on course to eliminating schistosomiasis by 2017.
In 2010, the Yemen Ministry of Public Health and Population (MPHP) launched a nationwide schistosomiasis control program (also covering soil-transmitted helminths – STH) with a US$25 million IDA grant from the World Bank and partnerships established with the WHO and the Schistosomiasis Control Initiative (SCI). The MPHP’s strategy was to combine schisto and STH control with health, education, via schools and outreach, and the concerted engagement of multiple sectors, such as agriculture, education,and water and sanitation.
Since 2010, more than 24.8 million praziquantel tablets for schistosomiasis have been delivered, in combination with albendazole for STH in coendemic areas. In 2014, disease remapping efforts showed that the number of highly-infected districts was down from 51 in 2010 to 3 and districts with low infection rates increased from 41 to 189, translating into low-infected districts now accounting for more than 87% of the country, up from 15% just five years ago.
Recent events prevented the national program from conducting assessments to determine how many districts had reached the targeted 1% infection rate. On reaching the WHO target, Yemen will be among the few countries to have eliminated the public health burden of schistosomiasis, having already achieved this for Guinea worm disease and lymphatic filariasis – a remarkable feat for the region’s poorest nation.
With events on hold, Yemen awaits the opportunity to resume assessment activities and determine its schistosomiasis elimination status. Yemen serves as a stark example of how even impressive gains made in combating NTDs decrease in an uncertain political environment.
Research and Development
Great progress has been made over the past year in pursuing research aimed at facilitating the efforts of national NTD programs to combat the diseases included in the London Declaration, and meet the WHO Roadmap targets. To further these advances, numerous donors, institutions and collaborators have been partnering to identify, support and carry out research across three principal categories: drugs, diagnostic tools, and operational research.
For the purposes of this report, an initial attempt has been made to capture any research that is ongoing or recently completed for each of these three categories with respect to the 10 London Declaration NTDs.
Research institutions, universities and consortiums, along with disease community networking groups, were contacted to contribute to and comment on a growing list of research efforts.
Although far from comprehensive, the preliminary list contains more than 150 unique investigations underway to develop much-needed drugs to treat affected communities and individuals, tools that will help programs scale up and scale down safely to achieve program targets, and improve methods for implementing program strategies.
Can we reach the 2020 goals using current strategies?
Epidemiological modelling has become an essential tool in developing public health policy for the control of infectious diseases and will be used to help achieve the WHO NTD goals. Modelling is a method for bringing together our understanding of the life cycle of the disease, transmission, clinical processes and health systems to project the likely impact of different strategies. An NTD modelling consortium has been formed to develop models across the diseases in the London Declaration (except Guinea worm), to support strategy development on the most effective control strategies to achieve the goals in particular settings.
As control programs scale-up their efforts to control NTDs and new tools are being developed in diagnostics, treatments, vector control and surveillance, there is a growing body of evidence and data on which we can base more refined public health strategies. The NTD modelling consortium aims to contribute robust, validated, mathematical and statistical analyses to support the effort to ensure the most effective strategies are used to achieve the goals.
Priorities for Progress and Advocacy
Later this year, the UN General Assembly (UNGA) will meet in New York to adopt 17 Sustainable Development Goals (SDGs) that will carry forward the momentum of the Millennium Development Goals (MDGs) as the sun begins to set on the MDGs timeline.
A number of the current SDGs are particularly pertinent to the multi-pronged and multi-sectored efforts to control, eliminate, and eradicate NTDs. Specifically, SDG 3 – Ensure healthy lives and promote well-being for all at all ages, references NTDs under sub-goal or target 3.3:
“By 2030, end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases.”
Given that target 3.3 explicitly mentions “the end of NTDs”, it is imperative that this NTD target includes a global indicator. The NTDs Department at WHO has been leading the process of defining an indicator for NTDs and achieved consensus for the following indicator from broader NTD community:
Proposed SDG indicator for NTDs:
“90% reduction in the number of people requiring interventions against NTDs by 2030.”
Specific actions that the NTDs community can take to support this are:
- contact the Inter-agency and Expert Group on Sustainable Development Goal Indicators (IAEGSDGs) established by the UN Statistical Commission to develop an indicator framework for the monitoring of targets at the global level and urge the inclusion of this NTD indicator;
- work with national government officials involved in the post-2015 development agenda and SDG process and urge for the inclusion of a global NTD indicator.
- contact your UN permanent representative in New York and urge for the inclusion of an NTD indicator.
G7 Leadership on NTDs
The conclusion of the 2015 Group of 7 (G7) Summit, held June 7-8 in Schloss Elmau, Germany, offers promising news for people around the world who continue to endure the crushing burden of NTDs. Under Chancellor Angela Merkel’s leadership, NTDs remained a priority on the 2015 agenda, devoting much needed attention and dialogue to an issue that affects the most vulnerable and neglected populations across the world.
Uniting to Combat NTD partners stand ready to marshal the very best talent, resources, knowledge and experience, to work side by side with the G7 to end these diseases once and for all. This year, 2015, offers a pivotal moment for the G7 to wrap up the unfinished NTD agenda and have an immediate, meaningful and sustainable impact, setting the stage for success as the world looks ahead to the new sustainable development goals.